A Complete Breakdown of CPB Domains, Subtopics, Skills Tested, Real-World Applications, and How to Study Each Area Strategically

If you’re preparing for the Certified Professional Biller (CPB) exam, one of the most important things to understand is exactly what topics will appear on the test. Knowing the content outline upfront allows you to build a smart study plan, choose the right materials, and focus on areas that carry the most weight.

As you work through this guide, keep your CPB Study Guide and CPB Practice Questions beside you—this article will help you map each domain to the parts of your study resources that matter most.

Let’s break down every topic on the CPB exam, what the questions look like, and how to study each section effectively.

👉 Let’s walk through this together, clearly and calmly. Check out our AAPC CPB 2025 Practice Questions with Detailed Rationale - fully updated for the latest 2025 billing guidelines to help you deepen your knowledge of claims processing, reimbursement methodologist, compliance requirements, and insurance fundamentals. Each question includes a clear, easy-to-follow rationale so you understand the "why" behind every answer and build real confidence for exam day. You've got this!

Overview: The CPB Exam Content Structure

The CPB exam covers eight major domains, each representing a key part of the revenue cycle and billing workflow.

Here is the official breakdown:

Together, these domains form a full-picture test of billing competence.

The exam doesn’t measure memorization. It evaluates how well you understand the billing cycle, payer rules, compliance laws, and problem-solving skills in real-world revenue management.

Let’s break each domain down in depth.

 

1. Types of Insurance (10%)

Understanding insurance programs is the foundation of accurate billing.

You must know how to bill:

• Medicare Parts A, B, C, D
  
• Medicaid
  
• TRICARE
  
• Workers’ Compensation
  
• Commercial plans (PPO, HMO, EPO)
  
• Managed care models
  
• Self-pay processes
  
  

What CPB questions look like in this domain:

• “Which payer is primary when a patient has Medicare and employer insurance?”
  
• “What is required for TRICARE referrals?”
  
• “Which type of plan requires prior authorization most frequently?”
  
  

Why this domain matters:

Insurance determines payer rules, reimbursement logic, and claim submission requirements.

How to study:

Use your CPB Study Guide to map out payer differences.
Use CPB Practice Questions to reinforce sequencing rules (primary vs. secondary).

2. Billing Regulations (15%)

This section focuses on the laws, rules, and compliance guidelines that govern medical billing.

Topics include:

• OIG compliance program
  
• CMS regulations
  
• Fraud and abuse laws
  
• Affordable Care Act guidance
  
• Anti-kickback rules
  
• Stark Law basics
  
• CMS billing requirements
  
• Administrative Simplification
  
  

What exam questions may look like:

• “Which of the following is considered abuse rather than fraud?”
  
• “What should an internal audit include under OIG guidelines?”
  
• “Which regulation focuses on preventing improper financial relationships between providers?”
  
  

Why this domain matters:

Regulations protect the integrity of the healthcare system—and mistakes can lead to audits, penalties, and legal risk.

How to study:

Focus on understanding compliance principles, not memorizing laws.
The CPB Study Guide explains regulations in workflow context.

3. HIPAA and Compliance (10%)

This domain digs deeper specifically into HIPAA and security rules.

You must understand:

• HIPAA Privacy Rule
  
• HIPAA Security Rule
  
• PHI handling
  
• Minimum necessary standard
  
• Breach notification requirements
  
• Security safeguards (administrative, technical, physical)
  
  

What exam questions look like:

• “Which situation is considered a HIPAA violation?”
  
• “What safeguard prevents unauthorized electronic access?”
  
• “When must a patient be given a Notice of Privacy Practices?”
  
  

Why this domain matters:

Billing staff handle sensitive financial and medical data daily—HIPAA knowledge prevents violations.

How to study:

Review HIPAA rule summaries inside your CPB Study Guide.
Use scenarios in your CPB Practice Questions to practice identification of violations.

4. Reimbursement & Collections (15%)

This domain tests your ability to get claims paid.

Topics include:

• Payment posting
  
• ERA/EOB interpretation
  
• Coordination of benefits
  
• Denials and appeal processes
  
• Medical necessity
  
• Timely filing limits
  
• Deductibles, coinsurance, copays
  
• Collections and patient responsibility
  
• Balance billing rules
  
  

What exam questions look like:

• “A claim is denied for lack of medical necessity. What do you do first?”
  
• “Which item on an EOB shows patient responsibility?”
  
• “Which type of denial requires a corrected claim versus an appeal?”
  
  

Why this domain matters:

Billing is not complete until the payer reimburses correctly.

How to study:

Learn the denial categories and appeal logic through your CPB Practice Questions.
Study flowcharts and examples in your CPB Study Guide.

5. Billing Processes (20%) — The Largest Domain

This is the most heavily weighted section of the exam.

You must understand the full billing cycle:

From:

• Patient scheduling
  
• Insurance verification
  
• Preauthorization
  
• Charge entry
  
• Claim creation
  
• Claim submission
  
  

To:

• Payer processing
  
• EOB/ERA interpretation
  
• Payment posting
  
• Secondary billing
  
• Follow-up
  
• Collections
  
  

What exam questions look like:

• “What step must be completed before submitting a clean claim?”
  
• “Why would a claim be returned rather than denied?”
  
• “Which department handles coordination with coders for code edits?”
  
  

Why this domain matters:

This is the core of revenue cycle management.
If you master this domain, you dramatically increase your chance of passing.

How to study:

Use visual diagrams in your CPB Study Guide to understand workflow.
Practice sequencing questions using your CPB Practice Questions.

6. Coding Knowledge (10%)

You are not expected to be a coder, but you must understand how coding influences billing.

Topics include:

• CPT basics
  
• HCPCS basics
  
• ICD-10-CM basics
  
• Linking diagnosis to procedure
  
• Modifiers and their impact
  
• Global periods
  
• Medical necessity rules
  
• NCCI edits
  
  

What exam questions look like:

• “Which modifier prevents claim denial for bilateral services?”
  
• “Which ICD-10 code supports this CPT procedure?”
  
• “Why would a CPT code deny due to bundling?”
  
  

Why this domain matters:

Coding is the language of billing—if codes and diagnoses don’t align, payers don’t pay.

How to study:

Review coding-billing interaction examples, not full code sets.

7. Case Management & Coordination (10%)

This domain reflects the teamwork nature of billing.

Topics include:

• Communication with coders
  
• Coordination with providers
  
• Patient communication
  
• Insurance communication
  
• Compliance team coordination
  
• Referral and authorization follow-up
  
  

What exam questions look like:

• “Which department should the biller contact for missing documentation?”
  
• “Who should be notified when payers require additional clinical notes?”
  
  

Why this domain matters:

Billing is one big collaboration process—not a solo task.

How to study:

Use real-world logic and workflow reasoning.

8. Resource Use (10%)

Billing requires proper use of information tools.

Topics include:

• Payer websites
  
• CMS manuals
  
• Local Coverage Determinations
  
• National Coverage Determinations
  
• Fee schedules
  
• Employer benefits portals
  
• Internal documentation
  
  

What exam questions look like:

• “Where should you verify Medicare billing guidelines?”
  
• “Which resource provides coverage rules for a specific CPT code?”
  
  

Why this domain matters:

Efficient billers use tools correctly—reducing errors and preventing denials.

How to study:

Practice locating correct references during mock practice (mentally).
Understand which resource answers which type of question.

 

What the CPB Questions Actually Look Like

The CPB exam rarely asks:

❌ Definitions
❌ Pure memorization
❌ Legal citations
❌ Code lookup questions

Instead, it asks:

✔️ Practical workflow questions

✔️ Real payer scenarios

✔️ Denial reasoning

✔️ HIPAA/security decisions

✔️ Problem-solving questions

✔️ Coordination questions

✔️ Next-step logic

For example:

A claim was denied because the modifier submitted is invalid for the procedure. What should the biller do next?

This requires understanding of:

• Modifier rules
  
• Payer policy
  
• Correcting and resubmitting claims
  
• Coordination between billers and coders
  
  

This scenario-based reasoning mirrors the daily work of a biller.

 

How to Study Each Domain Strategically

Here’s the most effective plan:

1. Study the domains in order of weight

Start with:

• Billing processes (20%)
  
• Billing regulations (15%)
  
• Reimbursement (15%)
  

These three domains equal half the exam.

2. Use real-world billing logic

Ask yourself:

• What would a real biller do first?
  
• Who should receive this information?
  
• Which department solves this?
  
• What does payer policy require?
  
  

3. Practice scenarios, not definitions

Your CPB Practice Questions are essential for this.

4. Use visual diagrams

Billing is a process—seeing it mapped out helps.

5. Study consistently

Aim for:

• 1–2 hours daily
  
• 6–8 weeks total
  
• Weekly practice exams
  
  

What Domain Most Test-Takers Struggle With

The top three hardest areas:

• Compliance and HIPAA
  
• Medicare rules and payer differences
  
• Denials and appeals logic
  

These topics require deeper understanding—not memorization.

Your CPB Study Guide explains these in plain language, and your CPB Practice Questions reinforce the logic.

Pro Study Tip 📘

Treat each domain as a puzzle piece. When you fit them together—insurance, coding, reimbursement, compliance—you’ll see the complete picture of the revenue cycle. The CPB exam becomes far easier when each part connects logically in your mind.

 

👉 Let’s walk through this together, clearly and calmly. Check out our AAPC CPB 2025 Practice Questions with Detailed Rationale - fully updated for the latest 2025 billing guidelines to help you deepen your knowledge of claims processing, reimbursement methodologist, compliance requirements, and insurance fundamentals. Each question includes a clear, easy-to-follow rationale so you understand the "why" behind every answer and build real confidence for exam day. You've got this!

Final Thoughts

The CPB exam covers everything a biller needs to perform professionally and accurately in real-world healthcare settings. The content outline includes insurance, compliance, reimbursement, workflow, coding interactions, and communication—all essential to the revenue cycle.

When you study each domain with intention, follow a structured plan, and practice realistic scenarios with your CPB Practice Questions, the exam becomes predictable and manageable.

Your CPB Study Guide gives you the foundation.
Your CPB Practice Questions give you the application.
Your effort gives you the certification.

You’re now fully equipped to prepare for every topic on the CPB exam.